Abstract
ObjectiveTo investigate if magnetic resonance spectroscopy (MRS) is the best Magnetic Resonance (MR)-based method when compared to gradient-echo magnetic resonance imaging (MRI) for the detection and quantification of liver steatosis in diabetic patients in the clinical practice using liver biopsy as the reference standard, and to assess the influence of steatohepatitis and fibrosis on liver fat quantification.MethodsInstitutional approval and patient consent were obtained for this prospective study. Seventy-three patients with type 2 diabetes (60 women and 13 men; mean age, 54±9 years) underwent MRI and MRS at 3.0 T. The liver fat fraction was calculated from triple- and multi-echo gradient-echo sequences, and MRS data. Liver specimens were obtained in all patients. The accuracy for liver fat detection was estimated by receiver operator characteristic (ROC) analysis, and the correlation between fat quantification by imaging and histolopathology was analyzed by Spearman's correlation coefficients.ResultsThe prevalence of hepatic steatosis was 92%. All gradient-echo MRI and MRS findings strongly correlated with biopsy findings (triple-echo, rho = 0.819; multi-echo, rho = 0.773; MRS, rho = 0.767). Areas under the ROC curves to detect mild, moderate, and severe steatosis were: triple-echo sequences, 0.961, 0.975, and 0.962; multi-echo sequences, 0.878, 0.979, and 0.961; and MRS, 0.981, 0.980, and 0.954. The thresholds for mild, moderate, and severe steatosis were: triple-echo sequences, 4.09, 9.34, and 12.34, multi-echo sequences, 7.53, 11.75, and 15.08, and MRS, 1.71, 11.69, and 14.91. Quantification was not significantly influenced by steatohepatitis or fibrosis.ConclusionsLiver fat quantification by MR methods strongly correlates with histopathology. Due to the wide availability and easier post-processing, gradient-echo sequences may represent the best imaging method for the detection and quantification of liver fat fraction in diabetic patients in the clinical practice.
Highlights
Non-alcoholic fatty liver disease (NAFLD) affects 10–30% of the general population across all ethnicities and age groups [1,2,3,4,5]
While some patients have isolated steatosis, others have non-alcoholic steatohepatitis (NASH), which can progress to cirrhosis, and are at increased risk for hepatocellular carcinoma [1,2,4,6,7]
In order to study a homogeneous population with NAFLD, patients with other chronic liver diseases were excluded, because some of them, like hepatitis C can be associated with fatty liver and with fibrosis
Summary
Non-alcoholic fatty liver disease (NAFLD) affects 10–30% of the general population across all ethnicities and age groups [1,2,3,4,5]. Obesity and diabetes are the primary risk factors. The prevalence of obesity, diabetes, and fatty liver is rising [1,3,4,5]. While some patients have isolated steatosis, others have non-alcoholic steatohepatitis (NASH), which can progress to cirrhosis, and are at increased risk for hepatocellular carcinoma [1,2,4,6,7]. NAFLD is the third most common indication for liver transplantation in the United States and is on a trajectory to become the most common indication [8]. Early diagnosis is important for appropriate treatments and to prevent progression
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